Understand Elle Macpherson's Cancer Treatment
- Supermodel Elle Macpherson recently told the Australian version of Women’s Weekly magazine that she was diagnosed with a type of early breast cancer called stage zero several years ago. The magazine said Macpherson’s cancer was positive for biomarker HER2 and also contained the estrogen receptor. The official name classification is ductal carcinoma in situ (DCIS).
- According to the magazine, the model had a tiny cancerous mass removed during a lumpectomy [a surgical operation to remove a lump from one’s breast]. A lumpectomy is done to take out only the tumor and a small portion of the tissue surrounding it.
- The report makes it seem as if Macpherson made an unusual decision to not receive chemotherapy because undergoing chemo after a lumpectomy is the standard of care follow-up treatment in the U.S.
- Not undergoing chemotherapy goes against the standard cancer care for stage zero cancer and the practice at most facilities across the U.S. However, there are significant studies being done on whether to treat, and how much treatment is needed, for stage zero breast cancer.
- It’s important to note that alternative therapies, which may be some of what Machperson pursued, have not been shown to improve cancer outcomes, and are thought to be dangerous. SurvivorNet experts do not support alternative therapies. However, when it comes to integrative and complimentary practices, there are many avenues which may be used on the advice of a doctor
- Additionally, doctors always recommend following standard care and SurvivorNet reports based on the standard of care guidelines offered via The National Comprehensive Cancer Network.
Macpherson chose to have the tiny cancerous mass in her breast removed during a lumpectomy [a surgical operation to remove a lump and the tissues surrounding it], however, her decision to not to undergo chemotherapy after her early-stage breast cancer diagnosis has lead to some misleading headlines that the Australian native and mom of two had actually chosen a controversial treatment path.
Read MoreDr. Esserman told SurvivorNet this week, “Surgery is standard of care for DCIS. Chemotherapy is never recommended for treatment of DCIS. The COMET study, for which we eagerly await the results, is a landmark effort to transform our approach and test the idea of active surveillance.
“We have just launched an exciting new study to test new approaches to risk reduction in DCIS. The RECAST DCIS (Re-evaluating Conditions for Active Surveillance suitable as Therapy for DCIS) will start with a non-operative approach.”
She continued, “Everyone can start with six months of surveillance and we used MRI imaging features to determine who is a good candidate to continue surveillance and avoid surgery. DCIS is a window of opportunity to rethink prevention.”
Additionally, she and another co-author for the study Dr. Kelly Hewitt, recently explained in The ASCO Post, “The trial randomly assigned patients with low- to intermediate-grade hormone receptor–positive DCIS to standard-of-care treatment or active surveillance, with or without the addition of endocrine therapy. If we can identify those patients who are at low risk for disease progression, we can, hopefully, save them from unnecessary and aggressive treatments. ”
It’s important to understand that this study will help doctors determine whether less treatment may be just as effective as doing more. Of course, the options are worth weighing depending on your individual diagnosis and concerns.
As for Macpherson, following her recent interview with Australian Women’s Weekly, about her cancer diagnosis, some news outlets, like the Daily Mail, have pointed out how some have dubbed decision to not be treated by chemo “shockingly irresponsible,” calling her “holistic” approach to battling cancer “unconventional.”
Macpherson, who also opens up about her cancer journey in her newly released memoir “Elle: Life, Lessons, and Learning to Trust Yourself,” told Australian Women’s Weekly, how a doctor informed her, back in 2017, that she had HER2 positive estrogen receptive intraductal carcinoma after having a lumpectomy done to remove the small mass in her breast. At the time she was advised to undergo chemotherapy and a mastectomy [surgical removal of one breast], something she chose not to do.
View this post on Instagram
She explained, “It was a shock, it was unexpected, it was confusing, it was daunting in so many ways. And it really gave me an opportunity to dig deep in my inner sense to find a solution that worked for me.
“I realized I was going to need my own truth, my belief system to support me through it. And that’s what I did. So, it was a wonderful exercise in being true to myself, trusting myself and trusting the nature of my body and the course of action that I had chosen.”
Her decision to not undergo chemo goes against the standard care and most facilities across the U.S., and it’s something doctors sometimes don’t recommend. There are significant studies being done on whether it’s necessary or how much treatment is needed in a battle against stage zero breast cancer.
It’s also important to note that alternative therapies/medicines have not been shown to improve cancer outcomes. SurvivorNet does not support alternative therapies. However, when it comes to integrative and holistic practices, more reporting is needed.
Macpherson’s 2017 diagnosis came just three years after she found a benign cysts in her breast. It also followed her journey to sobriety, which she embarked on in 2003 when she attended her first Alcoholics Anonymous meeting.
View this post on Instagram
“Sobriety was a huge turning point in my life, and it was empowering because it showed me that all the events in my life were like a string of valuable experiences that could give meaning to my life,” Macpherson explained to Australian Women’s Weekly.
“So by getting sober, I was able to see that instead of numbing it, instead of blocking myself from that pain, it actually became so uplifting for me. Alcoholics Anonymous is a roadmap for life. It’s such a powerful tool. And even a really spiritual one.”
Expert Breast Cancer Resources
- An Overview of Breast Cancer Treatment
- Digital Guide: Dr. Yara Abdou Breaks Down Next-Generation Sequencing & Breast Cancer Treatment
- FDA Warning: Robotically-Assisted Surgical (RAS) Devices Have Not Been Authorized for Breast Cancer Treatment or Prevention
- Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options
- How Does Molecular Testing Help Determine the Best Breast Cancer Treatment Option?
- Early Stage Breast Cancer: What to Know About Testing
As for her breast cancer treatment decisions, according to People, she writes in her new memoir, “I came to the understanding that there was no sure thing and absolutely no guarantees. There was no ‘right’ way, just the right way for me.
“Saying no to standard medical solutions was the hardest thing I’ve ever done in my life. People thought I was crazy. But I knew I had to make a choice that truly resonated with me. To me, that meant addressing emotional as well as physical factors associated with breast cancer … and that took courage.”
What is Stage Zero Breast Cancer?
Macpherson also wrote about how her family, including her son’s, 26-year-old Flynn and 21-year-old Cy, reacted throughout her cancer treatment decisions.
She writes in her book, Cy simply thought that chemo kills you. And so he never wanted me to do it because he thought that was a kiss of death. Flynn, being more conventional, wasn’t comfortable with my choice at all. He is my son, though, and would support me through anything and love me through my choices, even if he didn’t agree with them. My children were extremely supportive in their different ways but I knew they felt very scared.
“Arki [Arki Busson – her ex partner and dad of her two sons] was really supportive … He didn’t agree with what I was doing … Yet he wrote to me to tell me how proud he was of the courage I was showing. Of course he was scared because I’d decided not to take a conventional pharmaceutical route. He considered that extreme. I, on the other hand, felt the chemo and surgery route was extreme.”
As for her current health status, she told Australian Women’s Weekly, “In traditional terms, they’d say I’m in clinical remission, but I would say I’m in utter wellness. And I am!
“Truly, from every perspective, every blood test, every scan, every imaging test … but also emotionally, spiritually and mentally – not only physically. It’s not only what your blood tests say, it’s how and why you are living your life on all levels.”
As for whether she sought advice from late actress Olivia Newton-John, she admitted she did.
Macpherson said, “Yes, we spoke a few times when I was diagnosed and also through both of our healing journey. We did things differently, but we did share experiences with each other and how we feel and how we approach things.”
View this post on Instagram
Meanwhile, researchers like Dr. Shelley Hwang, MD, MPH, a Principal Investigator in the COMET study, which Dr. Esserman was involved in, is also “hoping to identify less invasive, more customized approaches to care” for those diagnosed with DCIS.
Dr. Hwang spoke with the Breast Cancer Research Foundation (BCRF) earlier this year about the controversy surrounding DCIS treatment approaches.
She explained, “Back in the day, we always used to think that DCIS would turn into cancer. A lot of what we’ve learned in the last 10 or 15 years is that there are many, many different kinds of ductal carcinoma in situ, including some DCIS that just stay within the ducts quite comfortably for the rest of the patient’s lives.
“And what we really need to move towards is a better understanding of what DCIS will have a greater likelihood of invading out into the breast tissue and becoming invasive cancer, and which DCIS is really going to stay confined to the ducts, in which case it’s a completely harmless condition.
“I think anytime a woman has something abnormal on a mammogram, I mean, forget about finding something. Anytime a woman goes for a mammogram, I would say that most women are fearful about what that mammogram is going to result in. And boy, if that finds some abnormality, even if it’s not cancer, it is a scary situation for most women,” Dr. Hwang continued. “I and others are hoping that by trying to identify different kinds of cancers and different kinds of pre-cancers, we can do a better job of being able to tell patients which ones are the ones that we really need to act on urgently and which ones are not an emergency and could probably be managed with a lot less invasive treatments that we’re currently offering.”
Should I Have a Lumpectomy or Mastectomy?
In regard to the COMET study, Dr. Hwang said she wanted to understand “whether DCIS really was a cancer and if it should be treated as such, or whether there could be a different way of managing DCIS.”
“For instance, if a woman, one of the 60,000 women that gets diagnosed [with DCIS] every year who goes to a surgeon’s office, now she’s only offered one option for management for DCIS, and that’s surgery. But what we are proposing is that if a woman has one of these low-risk DCIS conditions, she has less than 1 percent per-year likelihood of getting cancer,” she told BCRF.
“The COMET trial is a prospective randomized trial, and one group of patients are monitored very closely. And in the other group, they undergo surgery right away just as we would do for anyone else who’s diagnosed with DCIS. And then we follow them over the course of the next five to 10 years, and we have successfully recruited almost a thousand women, so 997 women who randomized as of January of 2023. So now we’re really excited to wait for the results of the study, which should be able to publish and report out in the next 12 months or so, and we’ll do an early look to see if it’s safe to keep patients on close surveillance rather than operating on them right away. And I think in the future as even better treatments evolve, those are the things that we want to offer to patients with low-risk DCIS including things like DCIS vaccines, which would really reduce the need for these patients to get surgery.”
Additionally, Dr. Hewitt and Dr. Esserman, both in involved in the same study as Hwang, wrote in The ASCO Post, “It is estimated that between 20% and 40% of DCIS cases will ever progress to invasive breast cancer. Currently, the standard surgical approach is to treat everyone with DCIS the same way we treat those with stage I disease. Women routinely undergo morbid and life-changing surgery and radiation treatments in an attempt to eradicate the risk for cancer. Approximately one-third of women diagnosed with DCIS undergo mastectomy for disease management, and many also choose contralateral prophylactic mastectomy.
“The psychological impact of any breast surgery is significant and often not fully appreciated until after irreversible surgical treatment. However, given the slow and likely low rate of disease progression, many women are undergoing what may very well be unnecessary interventions. It is incumbent upon us to investigate and provide more personalized treatment options for our patients.”
Stage Zero Breast Cancer
Stage zero breast cancer refers to Ductal Carcinoma In Situ (DCIS). DCIS are abnormal cells that line the duct in a breast. A normal breast is made up of lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
Learning About Stage Zero Breast Cancer (DCIS)
DCIS is not an invasive cancer, meaning it hasn’t spread outside the milk duct and it cannot invade other parts of the breast. In some instances, if left untreated, doctors believe that DCIS can evolve into a more invasive breast cancer, something which some doctors worried about for Macpherson. This is why historically, the standard treatment for DCIS is to remove it surgically and in some instances offer radiation as well.
However, many doctors aren’t sure if even that is necessary for DCIS, because it may or may not turn into cancer.
And in an effort to reduce the fear around the earliest stage breast cancer we want you to understand the definition and the debate around treatment.
Two important facts about DCIS breast cancer are:
- It doesn’t spread to other parts of the body.
- The risk of death is essentially zero.
RELATED: Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
As for the debate, some doctors don’t consider it cancer, but rather a collection of abnormal cells or a pre-cancer, which is why some women opt for a watch-and-wait approach.
Others may recommend the surgery route which usually involves a lumpectomy and potentially radiation as well. This somewhat more aggressive treatment (which is the standard protocol at major cancer centers) does have side effects, and potentially, long-term effects.
Dr. Elizabeth Comen Explains The Main Aspects Of Early-stage Breast Cancer
Less commonly, doctors and their patients will decide on more aggressive approaches depending on the amount of DCIS in the breast and a woman’s specific risk factors for future breast cancer. One reason some doctors may want to remove DCIS is if a biopsy reveals any evidence that a more invasive breast cancer could be present.
Meanwhile, a large study, known as the COMET study, is now in the works, looking at the benefit of active surveillance versus standard treatment.
This kind of study will help doctors determine whether doing less may be just as effective as doing more. In the meantime, the options are worth weighing depending on your individual diagnosis and concerns.
Considering a Mastectomy or Double Mastectomy
A double mastectomy is when both breasts are removed to get rid of cancer. The procedure may also be performed as a preventative measure for women who are at a very high risk of developing breast cancer.
READ MORE: An Overview of Breast Cancer Treatment
Following the procedure, some women may choose to have their breasts reconstructed and have implants put in, while others don’t have reconstruction at all.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, told SurvivorNet in an earlier interview. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
When Should You Consider a Mastectomy?
Dr. Port notes that these days, most women do opt to have some sort of reconstruction. The length of these surgeries can vary a great deal. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one’s own tissue (usually from the belly area) and transfer it into the breast area, but this is a much longer procedure.
“When you take tissue from another part of the body and transfer it to fill in the empty space where the breasts are, this is a very long operation,” Dr. Port says. “It can take anywhere from six to 12 hours because it’s really like having a tummy tuck and then transferring the tissue and grafting the tissue, connecting the vessels, so those tissues have blood flow to live in.”
Dr. Chirag Shah On The Debates Surrounding Radiation Treatments For Breast Cancer
Deciding the Right Course of Breast Cancer Treatment
Doctors treating breast cancer seek out markers on your particular cancer to help decide what course of treatment is best for you. This is due to the cancer cells possibly having what are known as receptors that help identify the unique features of the cancer.
The three main receptors are the estrogen receptor, the progesterone receptor, and the HER2 receptor. The estrogen and progesterone receptors go together because they are fueled by hormones. Think of the cancer cell as having little hands on the outside of the cell which grabs hold of proteins that help it grow. These proteins are sometimes called “ligands.”
An example of a type of ligand that can stimulate a cancer cell is the hormone estrogen. An estrogen receptor-positive breast cancer will be stimulated by estrogen to grow. In this instance, your doctor may offer you treatment to specifically target the estrogen receptor.
The Unique Features of Breast Cancer
Another important receptor to test for is the HER2 receptor. For HER2 positive breast cancers (like the stage zero cancer Macpherson was diagnosed with), therapies that uniquely target the HER2 receptor are essential to treating the disease.
Alternative Therapies: Don’t Believe Everything You Read on the Internet
After receiving a cancer diagnosis, many people will head to the Internet and search something to the effect of, “what’s the cure?”
Dr. Jason Westin, leader of the diffuse large B-cell lymphoma research team at MD Anderson Cancer Center in the Department of Lymphoma and Myeloma, has an important message: don’t believe everything you read.
“Sadly, there’s a lot of information on the internet that’s not well-curated,” Dr. Westin said.
Many of the answers that will likely pop up on the Internet include what are known as “alternative therapies.” These refer to treatments that people may choose in place of conventional medicine, and they can range from mind-body approaches and diet and nutrition choices to supplements, healing crystals, Chinese medicine, and Ayurvedic medicine. They’re touted all over the internet, and they often sound too good to be true.
That’s because they probably are, according to Dr. Westin, who said, “If there were treatment options that weren’t based on chemotherapies or targeted therapies that worked well for our patients, sign me up!”
RELATED: Alternative Therapies: Don’t Believe Everything You Read on the Internet
But it’s for a good reason that these therapies aren’t used at comprehensive cancer centers: they haven’t proven themselves effective in clinical trials, which are rigorous studies that test treatments in the population of people they’re intended to treat. Clinical trials test new treatments for safety and efficacy; every drug or treatment approved for widespread use by the U.S. Food and Drug Administration (FDA) has to have gone through multiple phases of clinical trials.
But it’s for a good reason that these therapies aren’t used at comprehensive cancer centers: they haven’t proven themselves effective in clinical trials, which are rigorous studies that test treatments in the population of people they’re intended to treat. Clinical trials test new treatments for safety and efficacy; every drug or treatment approved for widespread use by the U.S. Food and Drug Administration (FDA) has to have gone through multiple phases of clinical trials.
“Many patients wonder, ‘are [doctors] hiding a treatment that might be good for us?'” Dr. Westin said, adding that the answer is, “Absolutely not.”
Dr. Westin explained that, if there were to be something out there that worked better than the proven treatment options that doctors usually use such as chemotherapy or targeted therapies, researchers would be studying that something in clinical trials.
“And we are studying it,” he said. In fact, there are thousands of clinical trials underway studying new and potentially better treatment options.
Sometimes, the therapies or supplements you read about on the internet can be okand maybe even beneficialif they’re used with conventional medicine, not in its place. These options make up “complementary medicine,” which, when its used in tandem with conventional medicine, is called “integrative medicine.” Many doctors believe in integrative medicine, so long as they remain in the loop and give their patients the go-ahead before combining anything new with their treatment.
But the majority of doctors tend to be in agreement about the fact that these options should never replace conventional treatment. In 2018, researchers out of Yale University substantiated this through a study published in JAMA Oncology that found that patients who choose alternative therapies in the place of conventional medicine are twice as likely to die from their cancers. But unfortunately, a survey that same year found that nearly 40 percent of people believe that alternative therapies alone such as vitamins, minerals, or diet can cure cancer.
Alternative Therapies: Don’t Believe Everything You Read on the Internet
But even if you weren’t planning on foregoing the treatment that your doctor prescribes as you try out something you read on the Internet, it’s absolutely vital that you talk to your doctor first. Your oncologists who know the specifics of your cancer and the way the treatments you’re taking workare the only ones who will be able to tell you whether that “cancer-curing” supplement is going to interact negatively with your actual treatment. It may, for instance, cause the treatment to be less effective, or may wind up being harmful, or causing debilitating side effects.
That’s why Dr. Westin is adamant: “Make sure if you’re finding information the internet about something that sounds too good to be true, talk to your doctor about it,” he said, adding that, in addition to not being effective, these therapies can often cost a lot of money.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
